AB1379 PREDICTORS OF RADIOLOGICAL PROGRESSION IN PATIENTS WITH RHEUMATOID ARTHRITIS: A PROSPECTIVE OBSERVATION
Authors: O. Alekseeva, V. Rybakova, A. Smirnov, A. Volkov, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2022)

Objectives to identify the prognostic role of ultrasound signs (US) in radiologic progression in RA patients Methods 61 RA pts, mean age 50,0 [38,0; 59,0] yrs, mean disease duration 7 [4; 20] months were treated with MTX and biologics according to the Treat-To-Target concept. After first year of therapy management was following real clinical practice rules until the termination of the study (7 years FUP, median 7,7 [7,4;8,6]). Among them 40 patients with early RA, mean age 51,0 [43,0; 60,0], disease duration 5 [3; 6,5] months. The general characteristics of the group are presented in the Table 1. Hands and feet ultrasound (US) with grayscale (GS), power Doppler (PD), and destructive changes (erosion), according to the criteria of OMERACT, were analyzed before initiation of treatment and in 3, 6, 9, and 12 months after. Radiographs were obtained at baseline, at 12 months, 4 years, and 7 years, radiographic changes were assessed using Sharp/van der Heijde modified scoring method. Radiographic progression was documented based on Sharp/Van der Heijde modified score changes during the follow-up. Table 1. General characteristics Characteristic At baseline After 7 years follow up Median age, years 50,0 [38,0; 59,0] Disease duration, months 7 [4; 20] GS 6 [4; 9] PD 2 [1; 6] DAS 28 5,6 [4,8; 6,5] 4,03 [3,42; 4,74] ESR, mm/h 35,0 [13,0; 50,0] 22,0 [14,0; 36,0] CRP, mg/l 10,6 [3,8; 32,3] 3,0 [1,2; 8,8] Rheumatoid Factor, positive results 53 (87%) Anti-CPA, positive results 52 (85%) Mean erosion score 0 [0; 3] 3 [1; 11] Mean joint-space narrowing score 57,0 [31,0; 88,0] 98,0 [77,0; 110,0] Modified total Sharp score 70,0 [31,0; 88,0] 102,0 [78,0; 117,0] Results 52 ACPA+ (85%) and 9 ACPA− (15%) patients presented among the 61 patients with RA. RA progression by 4 years FUP was identified in 36% (22 p) of pts, by 7 years FUP was identified in 69% (42 p) of pts. During the 7 years FUP 42 of 61 patients had radiographic progression: the count of erosion increased from 0 [0; 3] to 3 [1; 11]. At the same time, on the background of therapy during the first year, a decrease in ultrasound signs of inflammation was determined according to the GS and PD: from 6 [4; 9] to 4 [2; 6] p = 0.000 and from 2 [1; 6] to 0 [0; 2] p = 0.000, respectively, and increase in the number of joints with erosions (from 1 [0; 2] to 2 [0; 3], p = 0.000). All pts divided into groups based increase in erosions according to radiography (Rg +) and without it (Rg-). In the group Rg + GS at baseline was significantly higher than in Rg- group (6 [5; 10] and 5 [1; 8], respectively, p=0.04). CRP at 3 months and at 6 months was significantly higher in RG+ group than in RG- group (4,15 [1,2; 8,7] and 1,2 [0; 3,5], respectively, p=0.03 and 2,35 [0,8; 10,1] and 0,4 [0; 4,3], respectively, p=0.025). Conclusion Thus, we obtained the first data on the important prognostic role of ultrasound in assessing the progression of early RA in a prospective seven-year follow-up. Disclosure of Interests None declared